Benign Prostatic Hyperplasia; A Review

Aim: Benign Prostatic Hyperplasia, sometimes referred to Benign Prostatic Enlargement, is one of the most common complications and is a term that describes a prostate measurably larger than normal, which affects men beyond their middle age. BPH is rarely life-threatening complication and characterized by a spectrum of irritative and obstructive symptoms and however, we know this symptoms are not specific to BPH and may occur in patients with prostate cancer. The risk of acute urinary retention increases with prostate size and severity of symptoms requires urgent hospitalization and often surgery. The aim of this review is the assessment of what we have known about BPH in last three decades.

Methods: the PubMed and Scopus databases were searched for clinical trial with the keywords of BPH and BPE, which were published from 1979 through January 2011 with relevant abstracts. This review clarifies the key points in medical management, traditional surgical treatment and also, minimally invasive treatment options in BPH.

Results: α-blockers cause a rapid improvement in urinary flow rate and BPH-related symptoms and 5α-reductase inhibitors have been demonstrate to reduce prevalence of prostate cancer and phosphodiesterase-5 inhibitors influence on lower urinary tract symptoms in addition to treat erectile dysfunction. In case of surgical treatment, transurethral resection of the prostate is the preferred method of surgery in most patients. It has to be mentioned indication of surgery is for cases with failure responses to medical treatment. Complication such as clot retention or bleeding occur in about 16% of patients and open prostatectomy is limited to cases with glands of volume ˃ 100 cm3. In case of minimally invasive treatment options, it is worth noting, laser prostatectomy can remove tissue bloodlessly with both holmium and ‘Green Light’ lasers. In addition, prostate stents can restore voiding in subjects with acute urinary retention, but nowadays are rarely used and thermotherapy has results similar to medical therapy in single treatment as transurethral ablation does.

Conclusions: today, the choice of BPH treatment requires a balance in clinical needs and considerations, the preference of patients and being cost-benefit treatment as a long-term therapy.